Customize a 6 page form for medical website

Customizing an online and coding it to where it can be fillable. Here is what the form contains: Name, address, insurance info, check boxes (like the sample forms I have added). (The sample forms are similar to the originals). The form is 6 pages.

A signature is needed at the end of the form. The doctor will purchase a tablet (Android or Mac) so his patients can fill out this medical form in his office, and also sign their signature using a touch screen tablet stylus pen. There should be a send button where the files will go to a secure location where medical staff can access them.

Developer should be familiar with security protocols and have a good command of English.

Sample work is a plus. You should tell us something about yourself, your experience and why you would be a good fit for the job. We just want to get to know you a little better.

Should also have an eye for design. We need the form to look exactly like the ones we will be supply.

Once I find the right developer for this project, will present the info to the client and if he agrees and pays, we will move forward.

We do not have a budget in mind so just tell us what something like this would cost. Remember you are not designing a new website, you will be developing a customized form on an existing website.

49 freelance ont fait une offre moyenne de 555 $ pour ce travail

Hi,
We've built similar form for a Health Care Agency website. So, can provide you the best possible solution.
http://thexeta.com/dev/vancouverhhc/job-application/
http://thexeta.com/dev/vancouverhhc/request-caPlus

Let's discuss over freelancer Personal Message Box for the proper estimation of cost and time.
I am myself developer so you will directly work with me. No mediators. No managers. No subcontractors.
see my recent Plus

Hello Dear,
Hope you are doing well !!
I have gone through your project description and as per my understanding you are looking for customization of 6 pages form for medical website. For fulfilling your requiremPlus

Hello,
We’re preferred freelancers thus very reliable and we'd like to help you with these forms.
See our skills at: http://www.a2design.biz/portfolio_
What's your current website built on?
Can you send a Plus

Hi,
I have read your post and understood your requirement.
I have great experience in handling /PHP/MySQL/HTML5/jQuery/Wordpress/Magento/Joomla/Drupal/AngularJS/node.js/CSS3/Java/Python/Django/Javascript/iOS/AndrPlus

Hello,
We do like your project and we are interested. The project is in the core of our expertise: Web Design, Development and User-experience and we are all confident that we can do an excellent job on this WebsPlus

Thanks for sharing document
" I have few quick questions to ask , Kindly Note - This is not a standard reply, I truly like your post, however I would first like to have a discussion for my questions.
Once we havePlus

Thank you for checking this bid proposal.
Myself is Aloysius.
Yes, i do confirm that what we need to do is to design the highlighted 6 medical forms mentioned.
I truly believe that my team are capable enoPlus

Hi, I have experience in web projects, if you check my reviews you will see that I have gotten excellent results from previous employers. If you have any questions or concerns please do not hesitate to contact me, thanPlus

Hello,
I have a few questions:
1. You mentioned that the form will be 6 pages and the form to look like the form you attached. Is it 6 pages with each form like the one you attached? Or is it the form you attachePlus

Hi there
this is very easy job for me
i need to discuss this project in details so please send me message when ever you got time.
you can check our work http://portfolio.ayudevelopers.com/
You can check my fPlus

Dear Customer,
Greetings from Dreamrun Technologies Private Limited
Hi My name is micky. I understood your requirement of customizing an online medical -patient registration form and Health record of the patient's, Plus

Dear Sir
we are capable of performing the required task perfectly with accuracy,
please let us know if you want to clarify in details..
if you want us to share our skill and previous work
please initiate the chat bPlus

Dear Sir. We claim to get it done perfectly for you EXACTLY in the way you want it - Kindly give we a chance and we will prove myself -
Ready to prove our words, let's get it done right away and I mean RIGHT AWAY !! Plus

I want to discuss this project with you further, let me know the best suitable time for you to schedule the meeting, Feel free to message me at any time, i used to be online 14 hrs in a day on this website so probably Plus

Hi there,
My name is Joel. I've read your brief and can see that you’d like to build a website. We are properly established company. My team has 6 years experience designing and developing websites for personal andPlus

Hello sir,, I have read the project description & requirements carefully. I have checked the both attachment , I am confident that i can do it on time.. I would be very obliged if u will give me a chance to talk to youPlus

HI SIR AWARD ME RIGHT NOW I M 100% CONFIDENT FOR THIS PROJECT!!!
I am ready to start this immediately. I am extremely eager and ready to go. I am all of the following; attentive, detailed, creative, dedicated, efficiePlus